The effect of diabetes on a stroke patient in Damascus Hospital

doi:10.21203/rs.3.rs-4867682/v1

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The effect of diabetes on a stroke patient in Damascus Hospital

https://doi.org/10.21203/rs.3.rs-4867682/v1

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Objective: This study aims to find the relationship between the presence of diabetes, its duration, type, treatment, and its risk on the incidence of stroke patterns.

Methods and materials: A retrospective observational stud, This study targeted patients attending Damascus Hospital. The sample was selected randomly, and data was collected between the years 2014-2024 AD according to a form in which patients’ information was recorded in detail.

Results: The incidence of ischemic stroke in diabetic patients is 37.2%, hemorrhagic stroke is 64.2%, embolic stroke is 66.7%, and hyperlipidemia is %. Type 2 diabetes is considered a risk factor for strokes, and this group is 2.59 times more likely to have a stroke compared to other types of diabetes (RR: 2.59; CI: [1.63-4.18]; P: 0.008), duration of diabetes more than 10 years constitutes a risk factor for ischemic attacks, and this group is 2.49 times more likely to have ischemic attacks compared to the rest of the groups (RR: 2.49; CI: [1.53-4.07]; P: 0.004), poor diabetes control is a risk factor for diabetes and they were 2.5 times more likely to have seizures than other groups (RR: 2.5; CI: [1.53-4.07]; P: 0.004).

Conclusion: Diabetes is one of the important risk factors for all types of strokes in patients attending Damascus Hospital

Cardiac & Cardiovascular Systems

stroke

diabetes

Damascus Hospital

Cardiovascular disease, including stroke, is a major health care problem in both developing and developed countries and has detrimental effects at the individual, family, and societal levels.[1]

Stroke and diabetes are two distinct conditions, but they share several commonalities and contribute to the increasing burden of cardiovascular disease and mortality worldwide.[2]

Both are increasingly prevalent, both are diseases that affect blood vessels, and both are associated with other vascular risk factors, such as hypertension and dyslipidemia. Diabetes is a well-established risk factor for stroke and may be associated with poor outcomes after stroke.

In fact, glucose dysregulation, of which diabetes is a manifestation, occurs in two-thirds of people who have an acute stroke and makes people with diabetes more likely to die or develop severe disability and less likely to benefit from the FDA-approved treatment (tissue plasminogen activator).[3]

On the other hand, cerebrovascular complications make diabetic patients 2–6 times more likely to suffer from stroke, and this risk is doubled in younger individuals, patients with hypertension and complications in other vascular beds.[4] Based on this hypothesis, the aim of this study is to investigate the relationship and impact of diabetes on stroke patients in Damascus Hospital.

Importance of the study

Epidemiological studies have shown that diabetes is an established, independent, but modifiable risk factor for stroke, whether ischemic or hemorrhagic stroke. It is necessary to note and highlight this type of study because diabetes is the epidemic of our time and has serious systemic complications. Good control of diabetes can reduce the occurrence of these complications and achieve a better life for patients.

Study objectives

This study aims to find the relationship between the presence of diabetes, its duration, type, treatment, and severity on the incidence of stroke patterns.

Study the relationship between the presence of diabetes, its duration, type, treatment, and severity on the incidence of post-stroke complications.

Shedding light on the types of stroke at Al-Mujtahid Hospital, identifying its complications, and methods of diagnosing them

Identifying modifiable and non-modifiable risk factors for stroke.

Study location

The regular ward, intensive care, neurology department and cardiology department in Damascus Hospital, where 400 patients with a primary diagnosis of cerebral palsy, aged over 20 years, were studied during the period from 1/22/2014 to 1/22/2024. The admission decision was based on age, clinical condition and CT scan or MRI.

Study type

Observational Study of the Cross-Sectional Study Retrospective type.

Patients

This study targeted Damascus Hospital visitors, where the sample was randomly selected, and about (400) patients were selected who met specific acceptance criteria, the most important of which was the presence of adequate information in the file, while all patients were excluded according to specific exclusion criteria

Inclusion criteria:

Patients admitted to the emergency or internal department at Al-Mujtahid Hospital who were treated within the hospital and were not referred to other hospitals, patients over the age of 20 years, patients with stroke of all types, males and females were included.

Exclusion criteria:

Patients whose important information for conducting the research was not explicitly documented in the files or had a lack of basic study information, and those with previous strokes were excluded. Patients with seizures, fainting, sepsis (meningitis), benign headache disorder (migraine, cluster headache, tension headache, etc.), and brain tumors were excluded.

Data Collection

Data were collected through a paper form and by referring to patient records in the hospital archives. The form included age, gender, habits (smoking, alcohol), systemic medical history, drug history, date of diagnosis of stroke and circumstances of its occurrence, the main cause of injury and the identification of modifiable and non-modifiable risk factors, laboratory tests, the presence of diabetes previously diagnosed through clinical examination, blood sugar and hemoglobin glucose, complications resulting from diabetes and complications resulting from stroke, and a detailed history of stroke, symptoms, types, methods of diagnosis, prognosis and its location, if any.

Statistical Analysis

These data were entered from the paper forms into a SPSS file version 25 to be analyzed and find the results for this study. Where the descriptive analysis (frequencies and percentages) was found for all variables in the study, and the inferential analysis included studying the existence of relationships and associations between many of the studied variables.

Tests that were used:

The T-STUDENT test and the Chi Square test were used to analyze the data and to study the relationship between the connected variables (diabetes and mass index) and the type of stroke.

The odds ratio (OR) was calculated to investigate the risk factors and the occurrence of stroke.

The relative risk (RR) was calculated to investigate the degree of risk for the occurrence of stroke according to the risk factors.

The confidence intervals (CI) were calculated at the 95% range for both the odds ratio and the relative risk.

The data were analyzed and the significance of the statistical differences was estimated using the program

28. statistical package for social sciences SPSS v

The differences were considered statistically significant at a P-Value probability value less than or equal to a significance level of 0.05 (Level of Significance)

The sample size was 406 patients who visited the Neurology and Cardiology Emergency Department at Damascus Hospital. We found that the most common age group among stroke patients is over 60 years old at a rate of 59.6%, followed by the age group 50–59 years old at a rate of 28.1%, followed by the age group 40–49 years old at a rate of 4.9%, while the age group 30–39 years old and 20–29 years old at a rate of 4.4% and 3% respectively. The percentage of males was 52.2%, while the percentage of females was 47.8%. The percentage of smokers was 29.6%, while the percentage of those who drink alcohol was 5.9%, and the average duration of smoking was 0.9 packets/year with a standard deviation of 0.4 packets/year.

Hyperglycemia was the most common cause of stroke, accounting for 32.5% of the total study sample, followed by uncontrolled hypertension, accounting for 25.1%, exposure to severe psychological stress, accounting for 16.7%, followed by cardiac causes, accounting for 7.9%, while external or surgical trauma accounted for 5.4% of each, and 4.9% of patients had an unknown cause, vasculitis, and oral contraceptive use, accounting for 0.5%.

The incidence of ischemic stroke was 80.8%, the incidence of hemorrhagic stroke was 17.2%, the incidence of embolic stroke was 1.5%, and the incidence of fatty stroke was only 0.5%.

The incidence of stroke patients diagnosed by CT scan was 64.5%, those diagnosed by MRI was 14.8%, and those diagnosed by MRI and CT scan was 20.7%.

The incidence of ischemic stroke in diabetic patients was 37.2%, and its incidence in non-diabetics was 62.8%, the incidence of hemorrhagic stroke in diabetics was 64.2%, and non-diabetics was 35.8%, the incidence of embolic stroke in diabetics was 66.7%, and non-diabetics was 33.3%, and the incidence of fatty stroke in diabetics was 100%.

The incidence of ischemic stroke in diabetic patients with diabetes duration of more than 10 years was 42.6%, in diabetic patients with diabetes duration of 5–10 years, and in diabetic patients with diabetes duration of less than 5 years was 21.3%, and the incidence of hemorrhagic stroke in diabetic patients with diabetes duration of 5–10 years, more than 10 years, and less than 5 years (44.4%, 44.4%, 11.2 respectively), and the incidence of embolic and lipid stroke was 100% in diabetic patients diagnosed more than 10 years ago. The rate of ischemic stroke in patients with type 2 diabetes is 82%, type 1 diabetes is 16.4%, and gestational diabetes is 1.6%. The rate of hemorrhagic stroke in patients with type 2 diabetes is 73.3%, type 1 diabetes is 22.2%, and gestational diabetes is 4.5%. The rate of lipid and embolic strokes in patients with type 2 diabetes is 100%. The incidence of ischemic stroke in those with blood sugar greater than 126 mg/dL was 91.8%, at 100–125 mg/dL it was 4.9%, and at 100 mg/dL it was 3.3%. The incidence of hemorrhagic stroke in those with blood sugar greater than 126 mg/dL was 77.7%, at 100–125 mg/dL it was 15.6%, and at 100 mg/dL it was 6.7%. The incidence of embolic and lipid strokes was 100% in those with blood sugar greater than 126 mg/dL. The incidence of ischemic stroke in those with HbA1c more than 7% was 67.2%, 29.5% for those with HbA1c more than 10%, and 3.3% for those with HbA1c less than 5.5%. The incidence of hemorrhagic stroke in those with HbA1c more than 7% was 64.4%, 26.6% for those with HbA1c more than 7%, 64.4% for those with HbA1c less than 5.5%, and 8.8% for those with HbA1c more than 10%. The incidence of embolic stroke was 100% for those with HbA1c more than 7%, and 100% for those with HbA1c more than 7%. The incidence of ischemic stroke in those who monitor their diabetes was 31.1%, 68.9% for those who do not monitor it, the incidence of hemorrhagic stroke was 20%, 80% respectively, and the incidence of lipidic stroke in those who do not monitor their diabetes was 100%. The incidence of ischemic stroke in those with uncontrolled diabetes was 55.7%, those with acceptable control was 39.3%, and those with good control was 4.9%. The incidence of hemorrhagic stroke in those with uncontrolled diabetes was 64.4%, those with acceptable control was 26.6%, and those with good control was 9%. The incidence of embolic stroke was 100% in those with uncontrolled diabetes, and 100% for fat embolism in those with acceptable control.

The duration of hospitalization in those with diabetes was 14.3 days, while in those without diabetes it was 7.6 days.

The most common arteries damaged as a result of stroke in diabetic patients were the left and right anterior basilar arteries at a rate of 62.5%, and the middle artery at a rate of 60%. There was a statistically significant relationship.

The incidence of renal sequelae was 90.1%, hearing loss was 75%, speech difficulty was 69.2%, vision disturbances were 61.5%, death was 59.4%, memory loss was 58.1%, behavioral changes were 44.3%, loss of muscle movement was 41.9%, pain and numbness was 35.8%, depression was 35.3%, difficulty swallowing was 31%, blood stasis in the leg was 33.3%, and respiratory paralysis was 25%.

Type 2 diabetes patients are a risk factor for strokes, and this group is 2.59 times more likely to have a stroke compared to other types of diabetes.

Duration of diabetes of more than 10 years is a risk factor for strokes, and this group is 2.49 times more likely to have a stroke compared to other periods.

Poorly controlled diabetes is a risk factor for stroke, and this group is 2.5 times more likely to have a stroke than other groups.

In a study in Isfahan, Iran [5] conducted on 116,316 entitled A cohort study of diabetes mellitus and its two types and the risk of stroke subtypes in women in 2007, they found that type 1 diabetes patients were 4 times more likely to have strokes, and 1.8 times more likely among women with type 2 diabetes compared to those without diabetes. Type 1 diabetes was associated with a 4-fold risk of hemorrhagic stroke, but there was no association with type 2 diabetes.

While in our study:

Type 2 diabetes patients are a risk factor for strokes, and this group is 2.59 times more likely to have stroke compared to other types of diabetes.

We conclude that this study differs from our study in terms of the type of diabetes that is most dangerous for stroke.

We did not study the risk of diabetes type on the type of hemorrhagic or ischemic stroke, each one separately, so comparison is not possible.

In a study in Switzerland [6], conducted on 611 patients entitled Stroke patterns, causes and prognosis in diabetic patients, they found that diabetic patients are exposed to stroke 1.34 times more than non-diabetics, while there is no significant relationship with the occurrence of hemorrhagic stroke.

In this study, they found that neither diabetes nor high blood pressure were associated with poor functional outcomes.

In complete contrast to our study, which showed different results and showed the consequences resulting from diabetes, but we did not address the consequences caused by high blood pressure because it is not the focus of our research.

In a Japanese study [7] conducted on 10,582 patients entitled Diabetes and the risk of stroke in Japanese women and men, they found that the percentage of females was higher than the percentage of males, 59.4% for females, 40.6% for males, different from our study in terms of gender, and in our study the percentage of males was higher than the percentage of females.

They found that the risk of ischemic stroke was almost twice as high compared to people without diabetes and had normal values. This study is completely identical to our study, as diabetic patients are 4.1 times more likely to suffer from ischemic stroke compared to non-diabetics.

They found that there was no significant relationship between high blood pressure and the occurrence of ischemic strokes, while in our study we found that patients with high blood pressure were 3.39 times more likely to suffer from ischemic stroke compared to non-diabetics.

In a Japanese study [8] conducted on 13,129 patients entitled Diabetes and the risk of stroke and its subtypes among the Japanese, they found that the risk of ischemic stroke for both sexes was about 2 to 4 times higher for diabetic patients compared to those with normal glucose levels. Significant increased risks of lacunar and embolic infarctions were also observed for both sexes and large artery occlusive infarctions in women in diabetic patients, and diabetes was not associated with the risk of intraparenchymal or subarachnoid hemorrhage in either sex.

While in our study, the most common arteries affected by stroke in diabetic patients were the left and right anterior basilar arteries (62.5%) and the middle artery (60%). There was a statistically significant relationship.

In a study conducted at the University of Cambridge [9] on 698,782 patients entitled Diabetes, fasting glucose concentration and risk of vascular disease, they found that the age group 40–59 years was exposed to stroke 2.1 times those of younger age. This study is similar to our study in terms of studying age as a risk factor for stroke.

Fasting glucose concentration was nonlinearly associated with stroke risk with no significant associations between 3.90 mmol/L and 5.59 mmol/L. Compared with fasting blood glucose concentrations of 3.90–5.59 mmol/L, stroke incidence rates were: 1.07 (0.97–1.18) for < 3.90 mmol/L; 1.11 (1.04–1.18) for 5.60–6.09 mmol/L; and 1.17 (1.08–1.26) for 6.10–6.99 mmol/L.

In subjects without a history of diabetes, information on fasting blood glucose concentration or poor fasting glucose status did not significantly improve measures of vascular disease prediction when added to information on several traditional risk factors.

Whereas in our study, high blood sugar was associated with a significant risk of stroke.

Ethics approval and consent to participate:

The Research Ethics Committee at the Syrian Private University and the ethical committees at the relevant Damascus Hospital approved the study protocol. Verbal informed consent was obtained from each participant prior to participation. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Consent for publication:

Not applicable.

Availability of data and materials:

All data related to this paper’s conclusion are available and stored by the authors. All data are available from the corresponding author on a reasonable request.

Conflict of interest:

The authors declare that they have no conflict of interest

Funding:

This research received no specific grant from SPU or any other funding agency in the public, commercial or non-profit sectors.

Acknowledgments:

We are thankful to the management of the Syrian Private University and for their support in the field of medical training and research. We would also like to thank Dr. Ahmad Nabulsi for his help and supervision in the paper, I would like to thank the doctors residing in Damascus Hospital for their assistance in collecting data.

Kidwell CS, Warach S. Acute ischemic cerebrovascular syndrome: diagnostic criteria. Stroke. 2003 Dec;34(12):2995-8. doi: 10.1161/01.STR. 0000098902. 69855.A9 Epub 2003 Nov 6. PMID: 14605325.
Donnan GA, Fisher M, Macleod M, Davis SM. Stroke. Lancet. 2008 May 10;371(9624):1612-23. doi: 10.1016/S0140-6736(08)60694-7. PMID: 18468545.
Donnan GA, Fisher M, Macleod M, Davis SM. Stroke. Lancet. 2008 May 10;371(9624):1612-23. doi: 10.1016/S0140-6736(08)60694-7. PMID: 18468545.
Bamford J, Sandercock P, Dennis M, Burn J, Warlow C (June 1991). "Classification and natural history of clinically identifiable subtypes of cerebral infarction". Lancet. 337 (8756): 1521–6. doi:10.1016/0140-6736(91)93206-O. PMID 1675378. S2CID 21784682
Janghorbani M, Hu FB, Willett WC, et al. Prospective study of type 1 and type 2 diabetes and risk of stroke subtypes: The Nurses' Health Study. Diabetes Care. 2007; 30:1730–1735. [PubMed] [Google Scholar]
Karapanayiotides T, Piechowski-Jozwiak B, van Melle G, et al. Stroke patterns, etiology, and prognosis in patients with diabetes mellitus. Neurology. 2004; 62:1558–1562. [PubMed] [Google Scholar]
Iso H, Imano H, Kitamura A, et al. Type 2 diabetes and risk of non-embolic ischaemic stroke in Japanese men and women. Diabetologia. 2004; 47:2137–2144. [PubMed] [Google Scholar]
Cui R, Iso H, Yamagishi K, et al. Diabetes mellitus and risk of stroke and its subtypes among Japanese: The Japan public health center study. Stroke. 2011; 42:2611–2614. [PubMed] [Google Scholar]
Collaboration TERF. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010; 375:2215–2222. [PMC free article] [PubMed] [Google Scholar]

The authors declare potential competing interests as follows: no thing

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The effect of diabetes on a stroke patient in Damascus Hospital

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Version 1

Abstract

Introduction

Methods and materials

Statistical Analysis

Results

Discussion

Declarations

References

Additional Declarations

Status:

Version 1